Rick Anthony | 4C Health Solutions

22/06/2018 44 min Episodio 32
Rick Anthony | 4C Health Solutions

Listen "Rick Anthony | 4C Health Solutions"

Episode Synopsis

Topics:

Fraud, Waste and abuse
ERISA Fiduciary Liability
Third Party Administrator (TPA)
Self-Insured Employers
Payment Integrity
Misaligned Incentives

 
In this episode, Michael introduces you to Rick Anthony, Executive Vice President for 4C Health Solutions. Join us as we discuss how 4C Health Solutions, a payment integrity solution, seeks to tackle the epidemic of healthcare fraud and waste for self-insured employers and government programs.
 
Here’s a glance at what we discuss in this episode:

Rick’s extensive experience as a benefit consultant and why he joined 4C Health Solutions
The problem with the Network Discount Model
The definition of fraud, waste and abuse in healthcare and how it accumulates to $300 Billion annually
How fraud can consistently go undetected within a health plan
How employer Fiduciary Liability is also applicable to employer health plans and the current risks employers may not be aware of
How 4C Health Solutions enables employers to uphold their ERISA fiduciary responsibility to take the steps necessary to protect the assets of employee health benefit plans
What 4C Health Solutions provides compared to a traditional auditing firm
4C Health Solutions’ process for reviewing an employer’s claims history and how they identify on average 7-20% of illegitimate claims
How 4C Health Solutions’ adjudication system prevents improper payments before they are paid without delaying the claims payment process
The category where most of the fraud, waste and abuse claims have been identified
The willingness of TPAs vs. other insurance carriers to work with 4C Health Solutions
The concept of an employer owning their data and why some carriers are resistant to contract language that specifies this ownership of data
4C Health Solutions breaks down barriers to provide employers with independent visibility into their health benefit programs
How 4C Health Solutions will leverage their data to help employers identify the most efficient providers who offer the highest quality care
4C Health Solutions’ fee structure options and typical return on investment for employers
Barriers that 4C Health Solutions has encountered resulting in employers not implementing their service
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